Welcome to the health provider tip-off form

Completing this form

When completing the form, please remember it doesn't matter how much or how little information you have, every detail is valuable. It should only take a few minutes of your time to complete.

This form allows you to provide information about a health provider, an organisation, or their employees. Should you require more information about what can be reported on this form please refer to Health provider related tip-offs page

Let's start

Part 1

*What do you want to tell us?

Part 2

*Who is this tip-off about?

(eg Dr John Doe, Family Pharmacy etc)

*Where and when did it happen?

(eg the address of the practice or the pharmacy; the date if you know it)

What is the identification/reference number (if known)?

(an identification/reference number could be a provider number, pharmacy approval number or an ABN - you may be able to find these on invoices, medicine labels or other documentation)

Almost done

Part 3

Your details (you can remain anonymous; however, providing your details will enable us to contact you if more information is needed. If you do provide us with your contact details, we will not reveal your identity in the course of our enquines - See our privacy notice below.)

Your name

Email address

Contact number(s)

Documents to support your tip-off?

If you have electronic documents you would like to attach to support your tip-off, please upload up to 5 related files here:

Remove filePlease only select a file of the correct typeRemove filePlease only select a file of the correct typeRemove filePlease only select a file of the correct typeRemove filePlease only select a file of the correct typeRemove filePlease only select a file of the correct type

Please select up to 5 files (Files can be of type doc, docx, xls, xlms, pdf or jpg)
and have a maximum size of 25MB in total for all the files.

Declaration

*By submitting this form, you declare you understand that deliberately giving false or misleading information is a serious offence.

Form successfully submitted

Thank you for your submission.

Your concern will be reviewed in accordance with the department’s compliance assessment procedures.

Whilst we appreciate the time you have taken to report this tip-off, privacy and secrecy provisions set out in legislation do not allow us to provide you with updates regarding the progress of our review.

Privacy Notice

Your personal information is protected by law, including the Privacy Act 1988, and is being collected by the Australian Government Department of Health for the purposes of investigating, assessing and responding to fraud or suspicious activity by health providers against the Australian Government's health related programmes.

You can get more information about the way in which the Department of Health will manage your personal information, including our privacy policy on our privacy notice page.